One urgent topic involves prior authorization of molecular and genetic
tests. In recent months, two major insurers instituted
prior-authorization requirements for their collective 80 million
beneficiaries. Because of these recent prior-authorization changes, many
labs find it exceedingly difficult to work with their client physicians
to obtain the necessary prior authorizations required to be paid.
Webinar participants will get the perspectives of both an experienced
attorney and an executive at one of the nation’s largest lab
billing/collections companies, to learn what is working for their
clients, and key steps labs and client physicians should be taking to
obtain more prior authorizations with less time and effort.

Another major source of concern for pathology groups is the more
frequent and intense audit process by government and commercial payers.
A growing number of health insurers are initiating audits to review
prior paid services, particularly to audit for proof of medical
necessity. When medical justification, documentation, or due diligence
is deficient during lab test claim audits, payers are seeking
recoupment. Because prevention is a key factor, the right way to
document lab test claims, implement a robust compliance programs, and
demonstrate that a program is being strictly enforced in order to avoid
potential issues will all be addressed.

As particular attention is now being paid by payers of all kinds to
patient billing compliance issues, participants will hear what their lab
needs to do to avoid adverse consequences in these areas. Finally,
regarding the trend of contract (or third-party) sales and marketing
representatives who sell lab and pathology services, kickback statutes
now applicable in this area will be discussed, and why attention to the
sales activities of both in-house and contract sales reps is crucial.

For more information about this webinar and to view details including
presenter biographies and pricing, click
here.